Provider Demographics
NPI:1720287949
Name:SANFORD, LAURA JEAN (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:SANFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 FLORIDA AVE S
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1719
Mailing Address - Country:US
Mailing Address - Phone:763-544-1000
Mailing Address - Fax:
Practice Address - Street 1:715 FLORIDA AVE S
Practice Address - Street 2:SUITE 206
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55426-1719
Practice Address - Country:US
Practice Address - Phone:763-544-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist